不同剂量他汀类药物对急性脑梗死的临床研究

发布时间：2018-05-28 13:00

  本文选题：瑞舒伐他汀 + 急性脑梗死　； 参考：《兰州大学》2017年硕士论文

【摘要】：目的:检测不同剂量他汀类药物对急性脑梗死(acute cerebral infarction,ACI)患者内皮祖细胞(endothelial progenitor cells,EPCs)、超敏C反应蛋白(high-sensitivity C-reactie protein,hsCRP)及美国国立卫生研究院卒中量表(nation institutes of health stroke scale,NIHSS)评分的影响,探索大剂量他汀类药物治疗ACI患者的益处。方法:选取2015年10月-2016年7月在兰州大学附属第二医院神经内科病房住院的首次发病72h内的ACI患者80例,按照纳入标准选择其中42例患者,随机分为瑞舒伐他汀10mg治疗组和20mg治疗组,共治疗21天,检测入院第1天(基线期)和治疗后21天的血脂指标;采用流式细胞仪检测外周血EPCs细胞的数量,CD34+KDR+CD133+CD45dim作为EPCs的细胞表面标记,分别检测入院第1天(基线期),治疗后7天、14天和21天的外周血EPCs数量的动态变化,并用ELISA法检测分别检测入院第1天(基线期),治疗后7天、14天和21天的hsCRP的水平。并入院第1天(基线期)、治疗后7天、14天、21天和30天的美国国立卫生研究院卒中量表(NHISS)评分。结果:1.两组治疗后TC、TG和LDL-C水平与治疗前相比均显著降低,HDL-C水平显著升高(P0.05),且20mg组的TC和LDL-C水平降低更显著(P0.05)。2.在治疗后两组患者的EPCs数量逐渐增高,与10mg组相比,20mg组在治疗后第14天、21天时EPCs水平增高更显著(P0.05),且两组的EPCs数量均随时间变化呈线性相关。3.在治疗后两组患者的血浆hsCRP水平均不断下降,与10mg组相比,20mg组在治疗后第7d、14d时hsCRP水平下降更显著(P0.05)。4.治疗后NIHSS评分逐渐改善,治疗后30天时,与10mg组相比,20mg组NIHSS评分改善更显著,差异有统计学意义(P0.05)。5.ACI发生72h内,外周血中EPCs数量与NIHSS评分呈负相关(r=-0.413,P=0.007);血浆中hsCRP水平与NIHSS评分呈正相关(r=0.556,P=0.000),外周血中EPCs数量与血浆中hsCRP水平呈负相关(r=-0.472,P=0.002)。结论:与10mg相比,20mg瑞舒伐他汀能更有效地改善ACI患者血脂水平,增加EPCs数量,降低hsCRP水平并在一定程度上改善神经功能缺损。但ACI患者能否长期服用大剂量他汀类药物治疗尚需大样本队列研究确定。
[Abstract]:Objective: to investigate the effects of different doses of statins on endothelial progenitor cells (EPCs), high-sensitivity C-reactie protein (hsCRPs) and institutes of health stroke scale (NIHSS) scores in patients with acute cerebral infarction (ACI). To explore the benefits of high-dose statins in the treatment of ACI patients. Methods: 80 patients with ACI were selected from October 2015 to July 2016 in the Department of Neurology, second affiliated Hospital of Lanzhou University, and 42 of them were selected according to the inclusion criteria. The patients were randomly divided into two groups: the 10mg group and the 20mg group. The serum lipids were measured on the first day of admission (baseline period) and 21 days after treatment. Flow cytometry was used to detect the number of EPCs cells in peripheral blood and CD34 KDR CD133 CD45dim was used as the surface marker of EPCs. The dynamic changes of the number of EPCs in peripheral blood were detected on the first day of admission (baseline phase, 7 days, 14 days and 21 days after treatment), respectively. The levels of hsCRP on the first day of admission (baseline period, 7 days, 14 days and 21 days after treatment) were detected by ELISA method. The first day of admission (baseline period, 7 days, 14 days, 21 days and 30 days after treatment) was scored by the National Institutes of Health Stroke scale (NHISS). The result is 1: 1. After treatment, the levels of TG and LDL-C in both groups were significantly lower than those before treatment. The levels of HDL-C in both groups were significantly higher than those before treatment, and the levels of TC and LDL-C in 20mg group were significantly lower than those before treatment. The number of EPCs in the two groups increased gradually after treatment. Compared with the 10mg group, the EPCs level in the 20mg group was significantly higher than that in the 10mg group on the 14th day after treatment (P 0.05), and the number of EPCs in both groups was linearly correlated with the change of time. Compared with 10mg group, the plasma hsCRP level of 20 mg group decreased more significantly than that of 10mg group on the 14th day after treatment. After treatment, the NIHSS score improved gradually, and the NIHSS score of the 20mg group was more significantly improved than that of the 10mg group at 30 days after treatment, and the difference was statistically significant within 72 hours after treatment. There was a negative correlation between the number of EPCs in peripheral blood and the score of NIHSS, the level of hsCRP in plasma was positively correlated with the score of NIHSS, and the quantity of EPCs in peripheral blood was negatively correlated with the level of hsCRP in plasma. Conclusion: compared with 10mg, rosuvastatin (20 mg) can effectively improve the blood lipid level, increase the number of EPCs, decrease the hsCRP level and improve the neurological function defect in patients with ACI. But large cohort studies are needed to determine whether ACI patients can take high-dose statins for long-term treatment.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.33

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